Complete guides to medical billing denial codes including CO, PR, and OA reason codes. Learn why claims are denied and how to appeal, correct, and prevent common denial types.
CO-96 is one of the denial codes that shows up across every specialty, every payer, and every billing department regardless of how experienced the team is. It means the payer determined the service is not covered under the patient’s plan. In cosmetic and aesthetic billing, CO-96 is not a surprise. It is the expected outcome. … Read more
Claim denials don’t just slow down your revenue. They erase it. In 2025, Experian Health’s 3rd Annual State of Claims Survey found that 41% of healthcare providers had at least 1 in 10 claims denied, marking the third consecutive year of increases. Among the most common culprits is the CO 97 denial code, and it’s … Read more
Before you spend time on a modifier, a corrected claim, or an appeal for a CO 97 denial, there’s one lookup that tells you whether any of that effort is worth it: the NCCI Procedure-to-Procedure (PTP) edit table. It tells you whether the code pair you billed is bundled, and if it is, whether a … Read more
Every CO 97 denial that gets caught before submission costs nothing. The same denial caught after submission costs an average rework fee, plus the time to research the NCCI pair, fix the modifier, and resubmit. The fix for that gap already exists in most practice management systems and clearinghouses; it’s just often sitting turned off, … Read more
Working CO 97 denials one claim at a time will always be reactive. The same NCCI bundling mistake can repeat across dozens of claims before anyone notices a pattern, because most billing teams review denials individually rather than in aggregate. A denial tracking dashboard flips that: instead of asking “why did this claim deny,” it … Read more
Here’s What the Reps Actually Said vs. What the Policy States A CO-197 denial means the service required prior authorization and either it wasn’t obtained or it wasn’t valid. That’s what the policy says. It’s clean, short, and almost completely useless when you’re staring at a remit with a $4,200 denial and a 45-day timely … Read more
Category: Surgical Billing | Nerve Surgery | Orthopedic Hand Surgery Coding Reading Time: 9 minutes Last Updated: June 2026 CPT 64999 is the more defensible billing choice for selective thumb CMC joint denervation. This applies when the surgeon has addressed the superficial radial nerve branches. It also applies when the lateral antebrachial cutaneous nerve branches … Read more